Why Do Senior Leaders in Health and Social Care Lose Confidence - and How Executive Coaching Can Help
- Dr Nichola Ashby
- Sep 1
- 3 min read
The Confidence Conundrum
Our health and social care clients have extensive experience. Many have been in the sector for decades and have worked across differing political environments, clinical leadership, academia and system delivery. So why then do we hear time and time again the goal setting, including confidence and clarity?
Senior leaders in health and social care juggle high-stakes decisions every day, tight budgets, and are under constant public scrutiny. When outcomes fall short, whether due to systemic pressures, policy shifts, or crises like a pandemic, their self-doubt can creep in. Over time, even the most accomplished leaders question their judgment and skills. The triggers may be learnt and seen from repetitive experiences, which leaves our caring healthcare professional feeling exposed, alone, and often vulnerable.
The common triggers for confidence erosion may be:
Rapid and consistent changes in regulations or funding models
Complex stakeholder expectations (commissioners, policy leaders, patients, families, regulators)
Public criticism after adverse events or errors
Chronic burnout and moral injury
Isolation at the top, with few peers to share vulnerabilities
Inconsistent power distribution, leaving individuals feeling disenfranchised, even silenced.
Each trigger chips away at the sense of competence and purpose leaders rely on to guide teams through chaos. This is how paralysis sets in. When confidence takes a hit, leaders experience a range of physical and mental reactions:
Analysis paralysis: overthinking every decision to avoid mistakes
Risk aversion: reluctance to innovate, make decisions or address tough issues
Emotional exhaustion: withdrawal from teams and loss of presence
Loss of authentic self: reluctance to speak up and make decisions
Imposter feelings: believing success is luck, not skill
Left unchecked, these responses can slow strategic initiatives, erode team morale, and deepen isolation.
Executive Coaching: A Catalyst for Reclaiming Confidence
Executive coaching offers a structured yet deeply personal way to rebuild self-trust and agency. Individuals will learn to clarify strengths and blind spots through 360° feedback and reflection. This will explore and reframe limiting beliefs (“I must never fail”) into growth mindsets based on strong values. Through coaching, individuals and teams can experience the practice of strategic confidence in safe, coached role-plays. This will anchor decisions in purpose and values, not just outcomes.
Coaching isn’t a quick pep talk. It’s a rigorous process of reframing thought patterns and building new leadership habits. I have openly commented that healthcare workers do not have access to coaching early enough in their career and this is often confused with models of mentorship, supervision and even assessment.
Coaching is most powerful when introduced as a process which will grow with the coachee. It can complement mentorship. Often, at the first signs of self-doubt or stress overload, it is too late. However, it is not a point of no return. During key transitions (new role, mergers, crisis responses and ahead of public-facing challenges (regulatory inspections, community forums, system and delivery change) coaching can be at its most potent. Coaching should be applied and supported through growth cultures as part of ongoing leadership development, before confidence cracks appear.
Early investment stops small cracks from becoming leadership crises.
Senior leaders in health and social care carry the weight of life-and-death decisions. When confidence falters, the ripple effects touch every corner of an organisation and system. Executive coaching restores more than skills; it reignites purpose, clarity, and the courage to lead again, to develop the culture which values and fosters everyone and the team.
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